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Analgesic + Antiemetic (Migraine Treatment)

Aspirin with Metoclopramide

Brand names: MigraMax

Adult dose

Dose: MigraMax sachets: 1 sachet (aspirin 900 mg + metoclopramide 10 mg) at onset of migraine; may repeat after 2 hours if required; max 3 sachets in 24 hours
Route: Oral (dissolved in water)
Frequency: At migraine onset; max 3 doses in 24 hours

Clinical pearls

  • Metoclopramide improves gastric emptying during migraine (gastric stasis impairs oral drug absorption), enhancing aspirin absorption
  • NICE NG150 (Headaches): aspirin + metoclopramide or aspirin + antiemetic is a first-line treatment option for acute migraine (alongside triptans)
  • Particularly useful when nausea and vomiting are prominent features
  • Metoclopramide should not be used for more than 5 days continuously — tardive dyskinesia risk
  • If oral triptans fail or not tolerated, MigraMax is a validated alternative for moderate-to-severe migraine
  • Dystonic reactions from metoclopramide: treat with procyclidine 5 mg IV/IM or benzatropine

Contraindications

  • Children and adolescents under 20 (Reye's syndrome risk from aspirin component)
  • GI haemorrhage, active peptic ulcer
  • Aspirin hypersensitivity
  • Metoclopramide: pheochromocytoma, GI obstruction, Parkinson's disease
  • Previous tardive dyskinesia from metoclopramide
  • Epilepsy

Side effects

  • Drowsiness (metoclopramide)
  • Extrapyramidal effects — dystonia (especially young women and children; metoclopramide)
  • GI upset (aspirin)
  • Bleeding risk (aspirin)
  • Tardive dyskinesia (with prolonged metoclopramide use — limit to acute use only)

Interactions

  • Other antiplatelet/anticoagulant agents — increased bleeding risk
  • Dopamine agonists — metoclopramide antagonises D2 receptors; avoid in Parkinson's
  • CNS depressants — additive sedation with metoclopramide

Monitoring

  • Migraine frequency and severity (diary)
  • Duration of metoclopramide use (short course only)
  • Extrapyramidal signs
  • GI tolerance

Reference: BNF; NICE NG150 (Headaches: diagnosis and management, 2021); British Association for the Study of Headache (BASH) Guidelines; https://bnf.nice.org.uk/drugs/aspirin-with-metoclopramide/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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